Examination of the Pregnant Woman at First Visit
· To diagnose pregnancy
· To identify high risk pregnancy
· To give advice for pregnant mother
As she walks in, observe any deformity, stunted growth, limp etc. does she look well or pale and tired?
Weight:-The average weight gain during pregnancy is about12-14 kg in the first trimester a woman should gain o.4 kg per month and in the second and third trimester she should gain 0.4 kg per week. It is Concedred as excessive if it is more than 3 kg a month during the second and third trimester; it is lessthan normal if it is less than 1 kg per month during the second and third trimester. Women who are under weigth coming in to pregnancy should gain more weigth than the average (0.5 kg per month or week rather than 0.4 kg). And may gains lessthan average (0.3 kg). Sudden increase in weight that suggests fliud retention or a loss of weight tht suggests illness should be carefully evaluated at prenatal visits.
Blood pressure: - Checked and recorded at each visit,
Face: - Oedema, sign of anaemia
Neck - Swollen glands
Asses the size, any Lumps in the breast
Nipples are they inverted or flat?
Teach the mother self - examination of the Breast
Heart and lungs are examined as usual to exclude diseases.
· To observe signs of pregnancy
· To assess fetal size and growth
· To assess fetal health
· To diagnose the location of fetal parts.
· To detect any deviation from normal.
· Note contour -is it round, oval, irregular or pendulous?
· Longtudinal, ovoid in primigravida
· Rround in multipara.
· Broad in transuerse lie.
b) Size:- Should correspond with the supposed period ofgestation
c) Skin: - The dark line of pigmentation which is lineanigra isseen any rash?
d) Strae gravidarum
e) Scar - Any operation scar(c/s)
At about 12 to 14 weeks of pregnancy, the uterus is palpated above the symphysis pubis as a firm globular sphere; it reaches the umbilicus at 20 to 22 weeks, the xyphoid process at 36 weeks, and then often returns to about 4 cm below the xyphiod due to “lightening” at 40 weeks.
Method: Measure distance of fundus with points on abdomenand assessing the fundal height in finger breadth below the xiphisternum or measure by centimeter.
Purpose- To know lie and presentation.
Method: - Use 2 hands using palms of hands palpate oneither side of the fundus. Fingers held close together, palpate the upper pole of then uterus and feel that as it is hard or soft or irregular.
Figure:12 Fundal palpation
Purpose-To know lie and position
Method: - always facing the mother, fix the hand on thecenter of the abdomen, fix the right hand and palpate with left hand and vise versa. Note the regularity; the regular side is the back.
Figure ; 13 Lateral palpation
Purpose -To Know Presentation & Attitude
Method: - Feel presenting part, is it hard or soft whilepalpatingfor the presenting part feel for eminences on back side.
Figure 14: Deep pelvic palpation
Figure 15. Pwlick’s grip
Auscultation: Check Fetal heart, rate and rhythm, count forone minute if regular.
Method: Use Pinards stethoscope
· hand should not touch it while listening,
· ear must be in close from contact with stethoscope,
· By x-ray of the pelvis
· Clinical (assessing sign of contracted pelvis)
· Head fitting
The head is the best pelvimeter
METHOD 1: Head fitting, sitting patient, Method
METHOD 2 : Left hand grip method Grasp the fetal head withleft hand and push it down wards and backwards if a sense of give is felt the head has entered and there is no over and no cephalo pelvic disproportion.
· Frequency of micturation
· Check for abnormal discharge
Varicosities: - Varicose veins may occur in the legs, anus(hemorrhoids) and vulva. Vulval varicosities are rare and very painful.
· Vulval warts
· Purulent irritating discharge
Examine for bones alignment and deformities.
Check pitting oedema in the lower limbs by applying fingertip pressure for 10 seconds over the tibial bone.